Summary
Overview
Work History
Education
Skills
Timeline
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Tracy Sims

Channahon,IL

Summary

Business-minded medical claims specialist with exemplary skills in customer service, claims processing and reimbursement. Bringing over 29 years of related experience combined with superior analytic and administrative abilities. Pursuing similar position with expanding company.

Overview

34
34
years of professional experience

Work History

Billing Specialist

R1 Rcm
01.2019 - Current
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Identified, researched, and resolved billing variances to maintain system accuracy and currency.
  • Worked with multiple departments to check proper billing information.
  • Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
  • Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
  • Collaborated with the collections team to recover overdue payments from clients, maintaining cash flow and minimizing writeoffs.
  • Maintained detailed records of each account''s payment history, providing easy access to information for audit and analysis purposes.
  • Reduced errors in financial records by conducting regular audits of billed accounts.

Claim Specialist

R1 RCM
05.2000 - 01.2019
  • Orchestrated day-to-day operations of billing department, including medical coding, payment posting, accounts receivables and collections for multiple cardiology groups
  • Set up and maintained new electronic billing system
  • Processed insurance company denials by auditing patient files, researching procedures and diagnostic codes to determine proper reimbursement
  • Daily submitted large volume of electronic and paper claims to insurance companies including Medicare and Medicaid to collect medical payments
  • Researched and followed up on denied insurance claims
  • Participated in workshops and other training opportunities to remain current on billing procedures, regulations and industry updates
  • Prepared billing statements for patients and ensured correct diagnostic coding

Patient Service Representative

Health Service Systems, Inc.
08.1991 - 02.2001
  • Determined proper course of action for claims processing
  • Worked with management team to implement proper division of responsibilities
  • Handled large volume of claims consistent with client and corporate policies, procedures, best practices and regulations
  • Documented and communicated timely claims information while supporting accurate outcomes
  • Balanced deposits and credit card payments each day
  • Posted miscellaneous payments to general ledger accounts
  • Efficiently posted payments and adjustments in accounting system
  • Resolved complex insurance and customer payment issues by providing options or escalating problems to supervisors

Education

High School Diploma -

Joliet Central High School

Working Towards Associate Degree

Joliet Junior College

Skills

  • Collaborative team management
  • Expertise in provider credentialing
  • Extensive knowledge of NextGen Practice Management System
  • In-depth knowledge of Athena PM System
  • Maintained PM system and files
  • Coached front office personnel
  • Proficient in reviewing and processing insurance claims
  • Set up and maintains all EFT/ERA payers
  • Extensive experience in transmitting claims and patient statements electronically
  • Knowledge of billing processes and tools
  • Insurance verification
  • Strong proficiency in managing revenue cycle

Timeline

Billing Specialist

R1 Rcm
01.2019 - Current

Claim Specialist

R1 RCM
05.2000 - 01.2019

Patient Service Representative

Health Service Systems, Inc.
08.1991 - 02.2001

High School Diploma -

Joliet Central High School

Working Towards Associate Degree

Joliet Junior College

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Tracy Sims